Infection and Drug Resistance (Jul 2020)
Clinical Features, Laboratory Characteristics and Prognostic Factors of Severity in Patients with Rickettsiaceae at Two Military Hospitals, Northern Vietnam
Abstract
Nam Le Van,1,* Chung Pham Van,2,* Manh Nguyen Dang,2 Thang Dao Van,1 Quyen Le T Do,1 Hung Vu Hoang,1 Tien Tran Viet,1,3 Binh Nhu Do1,4 1Department of Infectious Disease, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam; 2Institute of Clinical Infectious and Tropical Diseases, Military Central Hospital 108, Ha Noi, Vietnam; 3Director Office, Military Hospital 103, Ha Noi, Vietnam; 4Division of Military Science, Military Hospital 103, Ha Noi, Vietnam*These authors contributed equally to this workCorrespondence: Binh Nhu Do Email [email protected]: Rickettsioses are diseases caused by intracellular Gram-negative bacteria of the Rickettsiaceae family and transmitted through the bite of infected ticks or mites.Aim of Study: To investigate the clinical and subclinical characteristics and prognostic severe factors of the disease caused by Rickettsiaceae.Methods: A prospective, descriptive cross-sectional study was conducted at Department of Infectious Diseases of two military hospitals in Northern Vietnam from May 2013 to June 2019, in which 88 adult febrile patients caused by Orientia tsutsugamushi (50 patients) or Rickettsia spp. (38 patients) were enrolled. We recorded information regarding epidemiological characteristics (age, geography, residence, occupation), medical history, clinical and subclinical findings, life-threatening complications during treatment, outcomes and some factors predicting serious life-threatening complications in a case record form.Results: Scrub typhus (ST) patients had eschar (70%), skin-conjunctiva congestion (60%) and lymphadenopathy (44%). Rickettsia patients had a higher rate of maculopapular rash (39.5%), no ulcers and no lymphadenopathy detected. The majority of patients had elevated PCT > 0.05 ng/μL and increase in liver enzymes and thrombocytopenia. Major prognostic factors for severe complications included diffuse infiltrates on lung X-ray (OR: 19.5; p = 0.014), coarse crackles (OR: 18; p = 0.016), respiratory rate ≥ 25 cycles/minute (OR: 18; p = 0.016), shortness of breath (OR: 7.44; p = 0.003), pleural fluid (OR: 4.3; p = 0.035) and increase in AST ≥ 200 UI/l (OR: 4.42; p = 0.012). The PCT value is able to distinguish between the two groups with quite high reliability (the area under the ROC curve is 0.75).Conclusion: Eschar and peripheral lymphadenopathy were two valuable clinical symptoms for the diagnosis of scrub typhus and distinguishing 2 groups of diseases. Respiratory distress, increase in AST ≥ 200 UI/l and level of PCT were used as major prognostic factors in patients with Rickettsiaceae.Keywords: Rickettsiaceae, Orientia tsutsugamushi, Rickettsia spp., scrub typhus
